International Visiting Students Guide

International Visiting Students Guide

CHECKLIST FOR INTERNATIONAL VISITING STUDENTS STUDENT S NAME: Note: Do not staple your documents. Additional documents sent via fax, mail or email will not be accepted after your application has been received by our office. All documents must be received with your application or your application will not be processed. Please note, no fax, mail or email of any additional documents will be accepted after your application has been received by our office. Your application package should include the following: Checklist Complete Application* TOEFL Scores** Icahn school of Medicine Medical Status Form filled out completely Lab Reports Official School Transcript Letters of Recommendation (only 2 will be accepted) Letter of Good Standing which must indicate your expected graduation date Curriculum/CV (e-mail and home address must be listed on your CV) Copy of Biographical Passport Page Check for $1,000.00 (US) payable to Icahn School of Medicine *** (Note: Please add applicant name on the bottom of the check) BL or ACLS *The International Visiting Student application must be filled out in its entirety with the Title of School Official, Signature, Date and School Seal included. Only legible applications will be processed. Type application if possible. **Every applicant will be required to take a TOEFL test if he/she is from a non-english speaking country. The minimum test results to meet the Icahn School of Medicine at Mount Sinai requirements is 22-30 in each category. ***Application fee is $1,000.00 (US) which is non-refundable. Payment of application fee does not guarantee elective placement. We only accept Bank Draft, Money Order, Cashier s check or Travelers Checks which has a branch of the bank in the United States and made payable to Icahn School of Medicine. We DO NOT accept wire transfers.

Instructions & Directions for prospective International Visiting Students Icahn School of Medicine at Mount Sinai (ISMMS) accepts visiting students into the Elective Program based upon several criteria one of which is availability. Electives in various departments are offered by the Medical School Faculty at the following locations: The Mount Sinai Hospital Mount Sinai Beth Israel Mount Sinai St. Luke s Mount Sinai West New York Eye & Ear Infirmary of Mount Sinai Elmhurst Hospital Center The hospitals listed above are the only institutions in which international students are allowed to complete electives, if approved. Inquiries regarding specific electives offered at Icahn School of Medicine at Mount Sinai and its affiliates should be made directly to the International Visiting Student Coordinator, Jeanneth Persaud. Students who do not meet all the criteria will not be accepted. All applications are subject to approval by the Dean of Icahn School of Medicine at Mount Sinai. VISA: If you are accepted to complete an elective at The Icahn School of Medicine at Mount Sinai, please note you must obtain a B-1 Short Term Visa to participate in the program. Although institutions in the United States may allow you to participate under a different visa status,, you must obtain an B-1 visa to participate in electives at ISMMS. There are no exceptions. The following documents must be sent to the International Visiting Student Coordinator before your application can be considered for placement: APPLICATION: We do not acknowledge receipts of applications. Applications must be submitted 7 8 months in advance. ACCEPTANCE/DENIAL: An acceptance or rejection letter will be sent to the student via email about 10 12 weeks before the requested start date, providing that your application arrived 8 9 months in advance. Note: The original dates requested may change if the department has a specific elective block or if the date originally requested is not available. If the student is accepted, he/she must confirm acceptance via email. COMPLETED APPLICATION: Applications must be completed in entirety with the Dean s or Registrar s signature from your school and a school seal. Be sure your email address is clearly written and legible on your application. Core clerkship must be entered in the space provided on the application, or the application will be considered incomplete and will not be processed. Core clerkships are clinical rotations that every student must complete at their home university before they can graduate. NON-REFUNDABLE APPLICATION FEE: This $1,000.00 (US) fee must be paid in the form of Traveler s Check, Cashier s Check, International Money Order or Bank Draft drawn under a bank with a branch in the United States of America. No other source of payment will be accepted. We do not accept wire transfers. Absolutely no personal checks will be accepted. This application fee must accompany your application with all the required documents on the checklist or your application will not be processed. This fee does not guarantee you an elective and it is nonrefundable.

ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI MEDICAL STATUS FORM: The Medical Status Form must be completed by a medical provider or student health service. A copy of all applicable lab reports must accompany your application. If your Tuberculosis skin test (PPD) is positive, you must submit a chest x-ray or QuantiFERON results taken within one year prior to the start of your expected elective period. All results must be in English, if you are from a non-english-speaking country, then you must have it officially translated in English. SCHOOL TRANSCRIPT: Official School Transcript, in English, listing all courses you have completed in your medical school must be on the school s letter head with the school s seal and signature of a school official. This must be officially translated in English if you are from a non-english-speaking country. GOOD STANDING LETTER: Letter of Good Standing from the Dean s Office of your medical school. It must include your expected graduation date. SCORES OF EXAMINATION (OPTIONAL): A required passing score on USMLE-Step 1, as administered by the NBME can be added to your application, but is not a mandatory requirement. TOEFL TEST: This test is required by all students from non-english speaking countries. You must receive a score of 22-30 in each category in order to qualify for an elective at the Icahn School of Medicine at Mount Sinai. CURRICULUM VITAE (CV): Must accompany your application. If accepted: MANDATORY STUDENT HEALTH FEE OF $50.00 (US): This fee is payable on the first day of your elective by either credit card of check. This fee allows access to our Student Health facilities for minor illnesses. Please note that this does not replace comprehensive health insurance. TUITION: Students enrolled in the International Medical Schools will be charged tuition of $2,000.00 (US) per month on a pro-rate basis (maximum of 3 months), which must be payable in full on the first day of the elective. REGISTRATION: On the first day of the elective, the student must report to the Office of the Registrar, located at 1468 Madison Avenue, Annenberg Building, 13 th Floor, Room 13-30 in order to be officially registered. The student must present the following: Letter of Eligibility from New York State Department of Education Infectious Control Certificate of Completion CANCELLATION: Final confirmation of acceptance into an elective is binding unless unforeseen circumstances make participation impossible for the candidate. In this case, the candidate must notify the International/Visiting Student Coordinator immediately. DRESS CODE: Professional wear and comfortable shoes are recommended. No jeans or sneakers. Slacks, skirts, dresses and loafers are acceptable.

INTERNATIONAL VISITING STUDENT APPLICATION Office of the Registrar One Gustave L. Levy Place Annenberg Building-Room 1330 Box 1257 New York, NY 10029-6574 Phone 21244426 Facsimile 21369.6013 E-mail: : Registrar@mssm.edu Last Name First Name Middle Name Date of Birth E-Mail Address Month Day Year Address: Phone #: (include Country Code, City and Number) Citizenship Male Female Medical School I am currently a year student in a year program This section is to be filled out by a Dean or comparable school official of medical school where the student is enrolled. The medical student above is in good standing at this institution. He/She will will not pay tuition at our institution during the period indicated below. Personal health coverage is is not in effect while the student is away from our school. Malpractice insurance is is not in effect while the student is attending the elective. TITLE OF SCHOOL OFFICIAL SIGNATURE DATE SCHOOL SEAL List Core Clerkships that you will have completed at the time of your proposed elective: Clerkship Dates Clerkship Dates IF THE STUDENT HAS BEEN APPROVED TO TAKE THE ELECTIVE AND CANNOT ATTEND, AT LEAST TWO MONTH S NOTICE MUST BE GIVEN SO THAT OTHER STUDENTS ON THE WAITING LIST CAN HAVE THE OPPORTUNITY TO PARTICIPATE IN OUR ELECTIVES PROGRAM. HIPAA (Health Insurance Portability & Accountability Act, a Federal law) compliance is now required for all clinical students with exposure to patients. Students must successfully complete on-line training module and testing at Mount Sinai, regardless of previous HIPAA testing at other institutions. FOR DEPARTMENT USE ONLY DO NOT WRITE IN THIS SECTION The requested time is available is not available for the following dates: Begin TO End Department Contact Person Phone Number Revised April 2017

One Gustave L. Levy Place Annenberg Building Room 13-30 Box 1257 New York, NY 10029-6574 Phone: (212) 241-6691 Facsimile: (212) 369-6013 E-mail: Registrar@mssm.edu Electives Request Form This form must be submitted along with your application STUDE NT I NFO RM AT IO N Last Name: First Name: Middle Name/Initial: Email: Home School: ELE C TIVE CHOIC E S Instructions: Please list in order of preference and include the exact name of the elective and the entire code number, including the department prefix (e.g., PED, OBG, MED, SUR, etc.) Examples: Vascular Surgery S U R 0097 Mount Sinai Hospital mm dd yy - mm dd yy Cardiology M E D 0023 Mount Sinai Hospital mm dd yy - mm dd yy STUDE NT SIGN ATU RE : Student Signature: Date Revised April 2017

Icahn School of Medicine at Mount Sinai Medical Status Form. Student s name: To be completed by student: Do you have any illness that may interfere with your ability to work on a clinical service? Yes [ ] No [ ] If yes, specify: To be completed by the medical provider: Physical exam : within 12 months of school s start Screening for Tuberculosis a) For students with a previously negative PPD: PPD (not Tine test) within 12 months of the elective s start is required. PPD planted Date:_ month/day/year PPD read Date:_month/day/year Results: mm Interpretation: Positive[ ] Negative[ ] b) For students with a history of positive PPD: Chest x-ray or QuantiFERON within 12 months of the elective s start is required. Chest x-ray Date: month/day/year Copy of the x ray result must be submitted. Interpretation: c) For students with PPD conversion in the last 12 months: Chest x-ray within 12 months of the elective s start, proof of medication for latent tuberculosis and provider s attestation of absence of disease are required. Chest x-ray Date: month/day/year Copy of the x ray result must be submitted. Interpretation: Medication(s): Name(s)and Dosage(s) _ Dates taken:_month/day/year I attest that the student is free of symptoms: haemoptysis, cough, fever, night sweats, weight loss. Initials of medical provider: Titers and vaccines: COPY OF THE LAB REPORT TITERS WITH NUMERIC VALUES ARE REQUIRED. Measles Mumps Rubella Varicella** Hepatitis B TDaP* [] Immune [] Immune []Immune []Immune []Immune -------- []Not immune []Not immune []Not immune []Not immune []Not immune -------- If not immune, dates of vaccines Measles or MMR Month/day/year Mumps or MMR Month/day/year Rubella or MMR Month/day/year Month,day,year Month,day, year 3. Date: Month,day, year *If Td only was given, the student needs a dose of TDaP. No titers are required. ** Varicella titers are required even if the student had the disease. In compliance with the New York Health Code, I examined the above student. He/she is free from any health or behavioral issues I attest that the above information is true. Name: _Signature: _Date:_month/day/year Address/phone/email: